TeleHealth Benefit Program Enrollment

Step 1

Complete the Census Form. List all employees and indicate whether they are participating.

Step 2

Each participating employee completes the Application.

Step 3

Complete the Agreement for List Billing.

Return all completed documents to:

TBA Member Insurance Solutions
6505 Lee Highway
Chattanooga, TN 37421

Fax: 866.791.2806
Email: TBA@assoc-admin.com